Chronic Back Pain Treatment

What Is Chronic Back Pain

Chronic back pain is the leading cause of missed work, inability to participate in activities, and a hindrance to mobility. Chronic back pain can result from an age-related issue or an injury. The most common causes include: 

Musculoskeletal Issues

Musculoskeletal issues are among the most common causes of chronic back pain. These problems involve the spine's muscles, ligaments, and joints and can result from various factors such as injury, overuse, or degeneration. Some common musculoskeletal issues include:

1. Strains and sprains: Overstretching or tearing of muscles and ligaments in the back can lead to persistent pain and discomfort.
2. Joint dysfunction: Wear and tear or injury to spinal facet joints can cause inflammation and pain.
3. Spondylolisthesis: This condition occurs when a vertebra slips out of alignment, causing pressure on the surrounding nerves and tissues.

Disc-Related Problems

Disc-related problems occur when the soft, cushion-like discs between the vertebrae become damaged or displaced. Common disc-related issues include:

1. Herniated or bulging discs: A herniated disc occurs when the disc's inner material pushes through its outer layer, potentially causing pressure on the nearby nerves.
2. Degenerative disc disease: Age-related wear and tear can cause the discs to lose hydration, leading to reduced shock absorption and increased pain.
3. Arthritis of the spine — The gradual cartilage thinning inside the spine. 

Nerve Compression or Irritation

Nerve compression or irritation can result from various conditions affecting the spine, leading to chronic back pain. Some examples include:

1. Spinal stenosis: This condition is characterized by the narrowing of the spinal canal, which can compress the spinal cord or nerve roots.
2. Sciatica: Compression or irritation of the sciatic nerve, often due to a herniated disc, can cause pain that radiates from the lower back down the leg.

Inflammatory Conditions

Inflammatory conditions can also contribute to chronic back pain. These conditions cause inflammation of the spinal joints or tissues, resulting in pain and stiffness. Some common inflammatory conditions include:

1. Ankylosing spondylitis: This form of arthritis primarily affects the spine, causing inflammation and eventual fusion of the vertebrae.
2. Sacroiliitis: Inflammation of the sacroiliac joint, which connects the spine to the pelvis, can result in chronic lower back pain.

Lifestyle Factors

Certain lifestyle factors can increase the risk of developing chronic back pain or exacerbate existing pain. Some of these factors include:

1. Poor posture: Slouching or maintaining improper body alignment can strain the muscles and ligaments of the spine, leading to chronic pain.
2. Sedentary behavior: Prolonged sitting or inactivity can weaken the core muscles that support the spine, making it more susceptible to injury and pain.
3. Obesity: Excess weight adds stress to the spine, increasing the risk of degenerative changes and pain.
4. Smoking: Smoking has been linked to increased back pain, as it reduces blood flow to the discs, causing them to degenerate more rapidly.

Understanding the causes of your chronic back pain is an essential step toward finding the most effective treatment. Our team of experienced healthcare professionals will work with you to identify the underlying cause of your pain and develop a personalized treatment plan to help you regain control of your pain.

Diagnosis and Evaluation of Chronic Back Pain

It can be diagnostically challenging to determine the cause of chronic back pain. At Pain and Spine Specialists, we will review your pain history, current symptoms, and recent imaging to identify the root cause of your pain. Here are the diagnostic steps you can expect during your initial consultation with us:

Review of Medical History and a Physical Examination

The first step in diagnosing chronic back pain involves a thorough review of medical history and physical examination. During your consultation, our healthcare professionals will ask you about the nature of your pain, its onset, intensity, duration, and any factors that may aggravate or alleviate it. They will also inquire about any previous injuries, treatments you have tried, and your overall health status. The physical examination includes assessing your posture, range of motion, and muscle strength and identifying any areas of tenderness or discomfort.

Diagnostic Imaging

In some cases, our providers may request diagnostic imaging to identify the structural causes of chronic back pain. Our team may utilize one or more of the following imaging techniques to gain a better understanding of your condition:

• X-ray: This imaging method provides a detailed view of the bones in your spine, which can reveal issues such as fractures, arthritis, or spinal misalignment.
• MRI: Magnetic resonance imaging (MRI) offers a more in-depth look at the soft tissues surrounding the spine, including muscles, ligaments, and discs. An MRI can help identify herniated discs, spinal stenosis, or nerve compression.
• CT scan: A computed tomography (CT) scan combines multiple X-ray images to create a three-dimensional view of your spine. This technique can detect bone spurs, disc problems, or other abnormalities contributing to your pain.

Nerve Tests

In some cases, nerve tests may be necessary to determine if your chronic back pain results from nerve damage or irritation. Our team may recommend the following tests:

• Electromyography (EMG): This test measures the electrical activity of your muscles at rest and during contraction, which can help identify nerve or muscle dysfunction.
• Nerve conduction studies: By evaluating how well your nerves transmit electrical signals, nerve conduction studies can detect any damage or compression affecting the nerves responsible for your back pain.

Diagnostic Nerve Blocks

Minimally invasive injection procedures to determine the source of pain. These injections contain an anesthetic (and sometimes a steroid as well) that is delivered to a specific nerve or group of nerves to numb them. If the patient's pain significantly decreases after the injection, it can confirm that the numbed area was indeed the source of the pain. Here are few injections we use for this:

• Facet Joint Injections: These injections are used to identify whether the facet joints, the small stabilizing joints between and behind adjacent vertebrae, are the source of pain. The process involves injecting a local anesthetic (sometimes with a steroid) into the facet joint. If the patient experiences immediate pain relief, it confirms that the facet joint was causing the pain as the anesthetic has blocked the pain signals from that specific joint.
• Epidural Steroid Injections: This procedure involves injecting a corticosteroid, often combined with a local anesthetic, into the epidural space of the spine. This can help diagnose the source of pain by reducing inflammation around the spinal nerves, which can cause severe pain, numbness, or weakness. If the patient experiences relief from these symptoms following the injection, it suggests that the inflamed spinal nerves are the source of pain.
• Sacroiliac (SI) Joint Injections: Sacroiliac joint injections are used to diagnose and treat lower back pain associated with sacroiliac joint dysfunction. The doctor injects an anesthetic and anti-inflammatory medication into the sacroiliac joint. If the pain decreases significantly after the injection, the sacroiliac joint is likely the source of the pain.
• Medial Branch Blocks: Medial branch nerves are small nerves that feed out from the facet joints in the spine and carry pain signals from the facet joints to the brain. A medial branch block involves injecting a strong local anesthetic onto the medial branch nerves connected to a specific facet joint. If the block reduces or eliminates the patient's pain, it indicates that the facet joint or joints that the blocked nerves service are likely the source of the pain.

Through a comprehensive diagnosis and evaluation process, our healthcare professionals will pinpoint the cause of your chronic back pain and develop a tailored treatment plan to address your specific needs. 

Interventional Pain Management Techniques

Interventional pain management techniques can help effectively relieve chronic back pain and improve quality of life. Our team of healthcare professionals is committed to providing the latest interventional pain management strategies to help you experience lasting pain relief. Below are some of the techniques we offer.

Comprehensive Treatment Plans

We offer several treatment plans that can be seamlessly incorporated into your life. We do not believe in a "one-size-fits-all" approach to your pain. Our back pain specialists understand that each patient has unique needs. You may be suffering from chronic lower back pain, chronic middle back pain, or chronic upper back pain, and our experienced back doctors will determine the region of your pain and treat it effectively. Here are some factors we consider:

• The underlying cause of your pain
• The severity and duration of your pain
• Your overall health status
• Previous treatments and their effectiveness
• Personal preferences and lifestyle factors

With a thorough evaluation, our specialists will devise an individualized treatment plan to treat your chronic pain based on whether your pain is inflammatory pain, acute back pain, or chronic. We offer multiple modalities that can be incorporated collaboratively into your pain treatment, such as medication management, injections, and alternative therapies.